Wiki HELP -Post Op Casting denials....

[somountain@aol.com]

Our doc does total ankles... Post op there is a cast removal and another application - that is included in global fee ???

Pt had wound healing issues... so had to come in 2 weeks later for ANOTHER removal of cast (29705 & wound exam which required special medical honey application A6250) to wound AND another cast application (29405). Same procedure done another 2 weeks later. Diag Codes: aftercare (V54.81) and non healing wound (998.83)

Our claims are being denied after the 1st post op visit for everything ! I didn't use 58 modifier... is THAT the problem or am I NOT to bill for anything ? B/c of the wound healing - this case requires continual casting, etc.. that I explained above .

 

[lulu69]

You definitely need to apply modifier 58 for casts/splints applied to the surgial site during the postoperative period. Your diagnosis codes look good.
Many times supply codes beginning with an A are not covered ie the honey ointment, but the cast application and cast supply materials (fiberglass/plaster) should be paid

diagnosis codes, diagnosis coding

 

[lulu69]

I forgot to mention cast removals. The removal of a cast 29705 can only be billed if a different entity applied the cast initially. The CPT bok states , "Codes for cast removal should be employed only for casts applied by another individual." However this individual would have to work for a different business with a different tax ID, an outside provider.
However, if your provider is "applying" postop casts/splints then those can be billed with modifier 58

diagnosis codes, diagnosis coding